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Minimally invasive direct redo coronary artery bypass grafting
Atsushi Morishita1, Tadayuki Shimakura, Masayuki Miyagishima
1Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Hiroshima, Japan.
Insights
Minimally invasive direct coronary artery bypass grafting (MIDCABG) offers a safe and effective option for redo bypass surgery in high-risk elderly patients. This technique achieved successful revascularization and good long-term outcomes, avoiding sternotomy.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Coronary Artery Disease Management
Background:
- Redo coronary artery bypass grafting is increasingly necessary due to graft failure and new lesion progression.
- High-risk elderly patients often pose challenges for traditional median sternotomy approaches.
- Limited revascularization options exist for the left anterior descending artery (LAD) in these patients.
Purpose of the Study:
- To evaluate the safety and efficacy of reoperative minimally invasive direct coronary artery bypass grafting (MIDCABG) in elderly patients with high surgical risk.
- To assess the feasibility of MIDCABG for revascularizing the LAD and other target vessels in redo cases.
- To explore MIDCABG as an alternative to sternotomy and as part of hybrid revascularization strategies.
Main Methods:
- Seven patients underwent reoperative MIDCABG via left anterolateral thoracotomy.
- Target vessels included the LAD (7 patients) and the first diagonal branch (1 patient).
- Graft materials utilized were the left internal thoracic artery (LITA) and saphenous vein graft (SVG).
- Hybrid therapy and axillo-coronary bypass grafting were incorporated in select cases for complete revascularization.
Main Results:
- Complete revascularization was achieved in all seven patients.
- Postoperative angiography confirmed all grafts were patent.
- All patients were discharged post-procedure.
- During a mean follow-up of 2.4 years, one patient experienced recurrent angina due to graft failure after 3 years.
Conclusions:
- Reoperative MIDCABG via left anterolateral thoracotomy is a safe and effective technique for redo coronary artery bypass grafting.
- This approach provides a viable alternative for high-risk elderly patients, avoiding median sternotomy.
- MIDCABG can be integrated into hybrid revascularization strategies, combining minimally invasive surgery with percutaneous coronary intervention.
Abstract:
Redo coronary artery bypass grafting due to graft failure and the progression of new lesions has been increasing in frequency recently. We are often forced to revascularize only the left anterior descending artery (LAD) in very elderly patients with a high risk to median sternotomy. We performed reoperative minimally invasive direct coronary artery bypass grafting (MIDCABG) in seven patients. The target sites were as follows: LAD, 7; first diagonal branch, 1; and the graft material was the left internal thoracic artery (LITA), 7; and saphenous vein graft (SVG), 1. Complete revascularization was accomplished in all patients, by including hybrid therapy in three patients and axillo-coronary bypass grafting with SVGs in two patients. Postoperative angiography showed all patent grafts and all patients were discharged. During a mean follow-up period of 2.4 years (range: 0.5 to 3.5 years), all were free from cardiac events, except for one patient who had recurrent angina due to failure of a previously patent graft 3 years after redo MIDCAB. These results suggest that MIDCABG via left antero-lateral thoracotomy is an effective and safe technique in redo cases, as well as an alternative procedure for hybrid revascularization that combines minimally invasive revascularization of LAD with additional catheter interventional therapy.